Fournier’s Gangrene: Current Practices

Abstract

Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes.

Clinical Value of the Monocyte-to-Lymphocyte Ratio for Determining Number of Debridements in Treatment of Fournier’s Gangrene

“…21 VAC devices and hyperbaric oxygen therapy are commonly used in FG treatment in modern surgical practice, thereby supporting the wound healing process. 1,4 In our study, two patients underwent debridement and VAC application. However, we could not use hyperbaric oxygen due to lack of technical device in our center.…”

“…These include diabetes mellitus, malignant conditions, chronic alcoholism and other immunosuppressive conditions. 4 There are several scoring systems for mortality prediction in FG. Acute Physiology and Chronic Health Evaluation (APACHE) II is a commonly used scoring system predicting the mortality of critical patients.…”

A clinical study of management of Fournier’s gangrene in a rural hospital

“…In 1883, Jean Alfred Fournier, a French venerologist described three characteristics of this clinical condition; abrupt onset of scrotal pain and swelling in otherwise young healthy man, with rapid progression to gangrene of skin and subcutaneous tissues, with absence of definitive cause. 1 In majority of cases, foci of infection are colorectal (30-50%), urogenital (20-40%) and cutaneous trauma (20%). 2 Other associated comorbid conditions like diabetes mellitus, alcoholism, extremes of age, malnutrition, malignancy, chronic steroid use, and cytotoxic drugs have been documented.…”

“…2 Other associated comorbid conditions like diabetes mellitus, alcoholism, extremes of age, malnutrition, malignancy, chronic steroid use, and cytotoxic drugs have been documented. 1 It is a synergistic polymicrobial infection of both aerobic and anaerobic bacteriae. The infection spreads through tissue planes along Colle's fascia, Dartos fascia and Scarpa's fascia, causing microthrombosis of subcutaneous arterioles leading to gangrene of skin and subcutaneous tissues and cause severe endotoxicosis with development of multiorgan insufficiency.…”

“…1 If patient is in sepsis or its sequelae, aggressive treatment to stabilize hemodynamically should be priority. Early surgical debridement if delayed will have negative impact on prognosis of the patient.…”